POS 22: On Campus-Outpatient Hospital
POS 22 is the place of service code for hospital outpatient services on the main campus, including observation, hospital clinics, and same-day procedures without admission. Professional claims with POS 22 pay the Medicare facility rate; for a 2026 99214 that is roughly $84.50 versus $135.61 at an office.
- Setting
- Hospital outpatient department, on campus
- Rate type
- Facility (lower professional payment)
- Common pairing
- Observation E/M, hospital clinic visits, outpatient procedures
- Watch out for
- Admitted inpatients are POS 21, not 22
What does POS 22 mean?
POS 22 identifies an on campus-outpatient hospital: per CMS, a portion of a hospital's main campus that provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
It covers a lot of ground: observation units, hospital-based clinics, infusion centers, cardiac rehab, wound care, endoscopy suites, and outpatient surgery performed in the main OR without admission. What unites them is outpatient status plus on-campus location. The whole code family is laid out in our Place of Service reference.
When do you use POS 22?
Use POS 22 on professional claims when the patient was a hospital outpatient on the main campus at the time of service:
- Observation care, including the E/M services of the attending and consultants.
- Hospital-based specialty clinic visits (the hospital bills the facility fee).
- Outpatient procedures and same-day surgery in hospital ORs or procedure rooms.
- Interpretations of outpatient diagnostics; the professional component uses modifier 26 with POS 22 while the hospital owns the technical side.
Admitted patients are POS 21. Off-campus departments are POS 19. ER services are POS 23 even though the ER is on campus, because the ER has its own code.
How does POS 22 affect payment?
POS 22 pays the professional claim at the Medicare facility rate. Using 2026 national averages, a 99214 prices around $84.50 at POS 22 against about $135.61 at POS 11, before locality adjustment. The difference is practice expense that Medicare routes to the hospital's OPPS facility payment instead of your claim.
For a specialty group staffing a hospital clinic, that structure is the whole negotiation: if your physicians see 30 patients a day at POS 22, the professional collections alone may not support the practice, which is why hospital-based groups negotiate coverage stipends or PSA arrangements. Run the two-rate comparison for your actual code mix with the Medicare fee calculator before those conversations.
What are the common POS 22 errors and denials?
- Status mismatches: professional claim POS 22 while the hospital billed inpatient, or the reverse. Payers cross-check; the professional claim pends or denies until statuses align.
- POS 11 billed from hospital clinics: overpays the professional side while the hospital bills a facility fee, a classic audit recoupment. See the same trap from the other direction in POS 11.
- CARC 5 code-family mismatches, such as home visit or office-only codes with POS 22; translate remits via the denial code lookup.
- Global TC/26 errors: billing globally for diagnostics at POS 22 when the hospital owns the equipment; only the 26 component is yours.
Frequently asked questions
Yes. Observation is an outpatient status regardless of how long the patient occupies a bed, so professional services during observation carry POS 22. If an inpatient admission order is written later, services after that order switch to POS 21. This status boundary is the most common source of professional-claim denials for hospital-based groups.
Location relative to the main campus. POS 22 covers departments on the hospital campus or within roughly 250 yards of the main buildings; POS 19 covers off-campus provider-based departments. Professional payment is the facility rate for both, but the split feeds site-neutral payment rules that affect what the hospital collects on its facility claim.
Because Medicare pays twice for a hospital clinic visit: a facility fee to the hospital and a reduced professional fee to you. The practice expense built into the office rate moves to the hospital claim. In 2026 a 99214 averages about $135.61 non-facility versus $84.50 facility nationally, and that roughly $51 difference is the overhead Medicare assumes the hospital, not you, is paying for.
Frequently yes, because they face cost sharing on both the professional claim and the hospital's facility claim, and outpatient facility coinsurance can be substantial. Patients seen in a hospital-based clinic often cannot tell it is not a regular doctor's office, so warn them about the second bill or your front desk will spend the month fielding EOB calls.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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